Results
All the data from the aforementioned publications are summarized Tables
2, 3 and 4.
Table 2 summarizes prenatal and antepartum care guidelines. All
guidelines support some form of screening of pregnant patients depending
on symptoms and exposure, encourage the use of telehealth for prenatal
visits and limiting face to face visits and ultrasounds only to those
that are medically necessary. The use of antenatal corticosteroids for
fetal lung maturation can be continued till 34 weeks gestation, but the
use of steroids in the late preterm period, > 34 0/7 weeks
gestation remains controversial. All ultrasound equipment and patient
rooms should be appropriately cleaned after each use.
Table 3 summarizes intrapartum care guidelines. All guidelines
recommend a designated area within the unit to care for COVID-19
positive pregnant patients or Person under investigation (PUI). Timing
and mode of delivery should follow routine obstetric indications.
Cesarean delivery should be reserved for obstetric indications only;
infection with COVID-19 is not an indication for cesarean delivery
unless there is acute decompensation of mother or fetus. Only one
asymptomatic support person is allowed to be there at time of delivery.
Shortening second stage of labor can be considered with the use of
operative delivery or laboring down. Patients and healthcare workers
should be appropriately gowned gloved and have protective face masks;
specifically N95 should be used for aerosol generating procedures such
as forceful expiration during pushing. There is no contraindication to
regional or general anesthesia if indicated; but appropriate PPE use is
encouraged.
Table 4 summarizes postpartum care guidelines. All guidelines encourage
early discharge from the hospital, 1 day for vaginal delivery and 2 days
for cesarean delivery. This limits face to face exposure and increases
bed availability. Separation of mother and baby or discouraging
breastfeeding are not advised, unless the mother is acutely ill.
However, mothers are encouraged to 1) Practice respiratory hygiene
during feeding, 2) wear a mask, 3) Wash hands before and after touching
the baby and, 4) Routinely clean and disinfect surfaces they have
touched. Postpartum visits should be performed over telehealth, unless
face to face visit is essential to management.